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General NPI Number Information
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NPI Number | 1730110115
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Entity Type | Organization
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Legal Business Name | ST MARY'S INNOVIS HEALTH
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 07/03/2024
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Provider Practice Location Address
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Address Line | 211 FRAZEE STREET EAST
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City | DETROIT LAKES
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State | MN
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Zip | 56501
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Country | US
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Telephone | 218-847-3537
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Fax | 218-847-4405
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Provider Business Mailing Address
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Address Line | 211 FRAZEE STREET EAST
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City | DETROIT LAKES
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State | MN
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Zip | 56501
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Country | US
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Telephone | 218-847-3537
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Fax | 218-847-4405
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Authorized Official
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Title or Position | COO
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Name | MR. ALAN HURLEY
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Credential |
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Telephone | 701-364-7667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 263266
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 263266
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License Number State | MN
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 263266
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License Number State | MN
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